Utility of the Beck Depression Inventory to screen for and track depression in injection drug users seeking hepatitis C treatment.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. pholtzh@emory.edu

Abstract

OBJECTIVE:

Treating acute hepatitis C (HCV) in injection drug users (IDUs) is complicated by a high prevalence of psychiatric comorbidities that may lead to increased risk for depressive complications of interferon treatment. Effective screening strategies are needed to help non-psychiatric clinicians identify depressive disorders.

METHODS:

Thirty IDUs with acute HCV completed the Beck Depression Inventory (BDI), underwent a psychiatric examination, and were randomized to 24 weeks of pegylated interferon treatment (IFA) or observation (OBS). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the BDI for diagnosing depression (with a cutoff >10) were calculated. The psychiatrist's diagnosis was used as the gold standard. Depression severity was assessed over time with the BDI.

RESULTS:

Forty-seven percent of individuals met criteria for a depressive disorder. Sensitivity (91%) and NPV (92%) were high for the BDI; specificity (58%) and PPV (56%) were low. BDI worsened in 2 patients completing the study (one IFA, one OBS); two IFA patients were discontinued for possible depression-related complications. At baseline, subject-rated fatigue was associated with alanine aminotransferase level.

CONCLUSION:

The BDI is an adequate tool for ruling out depressive disorders in active IDUs with acute HCV, but specificity is low. Psychiatric consultation is recommended for all active IDUs being considered for acute HCV treatment.

Change in Beck Depression Inventory (BDI) Score from Baseline to Week 24 in Treatment (top) and Control (bottom) groups. Asterisks show participants taking antidepressant at any time during the study, including patients on antidepressant medications upon entering the study, started on medications at baseline or started on medications during the study. For one subject in the control arm (C10) with a BDI > 10, the study psychiatrist did not feel it was appropriate to start an antidepressant medication per the algorithm. Please see text for details.